Can performance-based financing be used to reform health systems in developing countries?
Can performance-based financing be used to reform health systems in developing countries?
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DOI：
10.2471/blt.11.87379
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发表时间：
2011-09-01
影响因子：
11.1
通讯作者：
Dujardin, Bruno
中科院分区：
文献类型：
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作者：
Ireland, Megan;Paul, Elisabeth;Dujardin, Bruno
在过去15年中，越来越多的发展中国家，特别是非洲国家，实施了基于业绩的筹资，作为提高卫生工作者业绩的一种手段。在布隆迪和卢旺达，扩大国家执行力度鼓励了基于业绩的筹资的支持者将其视为一种筹资机制，而越来越多地将其视为卫生部门改革的战略工具。我们反对这种观点，理由是基于成果和经济驱动的干预措施本身并不能充分满足病人和社区的需要，而这正是卫生系统改革的基础。我们还认为，围绕基于业绩的融资的辩论是有偏见的，因为没有充分考虑到背景，也没有理清基于业绩的融资方案的各种要素。
Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. We resist such a notion on the grounds that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. We also think the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package.